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• W3048284590 abstract "A female infant was born at term after an uneventful gestation. Immediately after birth, she exhibited inspiratory stridor and cyanosis, necessitating respiratory support with continuous positive airway pressure and oxygen supplementation. Once stabilized, she was admitted to the neonatal unit. The physical examination was unremarkable. Stridor worsened with vigorous breathing, crying was dysphonic, and severe episodes of airway obstruction occurred during oral feedings. The differential diagnosis included laryngomalacia, congenital vocal cord palsy, tracheoesophageal fistula, and a vascular ring. A gastric tube was inserted, and chest radiography confirmed passage of the tube to the stomach. Bedside airway ultrasound showed normal bilateral vocal cord movement and a near-total collapse of arytenoids during vigorous crying (Figure and Video 1; available at www.jpeds.com). Airway obstruction was mild on quiet breathing and disappeared during sleep (Video 2; available at www.jpeds.com). These finding were highly suggestive of laryngomalacia. The infant was sedated with dexmedetomidine (0.7 μg/kg) and midazolam (0.05 mg/kg) and airway endoscopy was performed. Laryngomalacia was confirmed (Video 3; available at www.jpeds.com). The subglottic area, trachea, and main bronchus were normal. Evolution was favorable, with improvement in stridor and dysphonia over the succeeding months. Laryngomalacia in the most common cause of stridor and airway obstruction in neonates and small infants.1Vijayasekaran S. Pediatric airway pathology.Front Pediatr. 2020; 8: 246Crossref PubMed Scopus (2) Google Scholar A clinical diagnosis suffices in most cases; however, severe or atypical (eg, biphasic stridor, dysphonia, choking) presentations require confirmation by direct visualization of the larynx during spontaneous breathing using airway endoscopy, which also serves to evaluate the inferior airway for additional or alternative diagnosis. However, the airway endoscopy procedure requires specialized equipment and staff and is not always readily available. Moreover, this technique is somewhat invasive and disturbing to the child and often requires sedation, which may obscure the precise evaluation of dynamic airway obstruction. Finally, the procedure itself or the use of sedation may be associated with such adverse events as hypoxia, hypercarbia, and laryngospasm. Airway ultrasound permits noninvasive evaluation of the larynx without the need for sedation. Relevant laryngeal anatomy, such as thyroid cartilage, vocal cords, and arytenoid cartilages, is readily visualized. Airway ultrasound allows assessment of the degree of glottic opening and vocal cord movement during inspiration and expiration, during quiet breathing and vigorous crying alike, permitting a genuinely dynamic assessment of the airway.2Daniel S.J. Bertolizio G. McHugh T. Airway ultrasound: Point of care in children—the time is now.Paediatr Anaesth. 2020; 30: 347-352Crossref PubMed Scopus (4) Google Scholar Airway ultrasound has been successfully used in the diagnosis of vocal cord palsy and, more recently, laryngomalacia, which together account for most cases of congenital stridor.3Huang H. Xia C. Hu M. Ma T. Zhu Q. Zhao H. The role of laryngeal ultrasound in diagnosis of infant laryngomalacia.Int J Pediatr Otorhinolaryngol. 2019; 124: 111-115Crossref PubMed Scopus (3) Google Scholar, 4Lee M.G.Y. Millar J. Rose E. Jones A. Wood D. Luitingh T.L. et al.Laryngeal ultrasound detects a high incidence of vocal cord paresis after aortic arch repair in neonates and young children.J Thorac Cardiovasc Surg. 2018; 155: 2579-2587Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar, 5Ongkasuwan J. Ocampo E. Tran B. Laryngeal ultrasound and vocal fold movement in the pediatric cardiovascular intensive care unit.Laryngoscope. 2017; 127: 167-172Crossref PubMed Scopus (39) Google Scholar Other well-known uses of airway ultrasound are to confirm endotracheal intubation and ultrasound-guided cricothyroidotomy.2Daniel S.J. Bertolizio G. McHugh T. Airway ultrasound: Point of care in children—the time is now.Paediatr Anaesth. 2020; 30: 347-352Crossref PubMed Scopus (4) Google Scholar Despite its many advantages, airway ultrasound is largely underused, and many pediatricians remain unaware of its potential in airway assessment and management. Our case shows how airway ultrasound may aid the clinician in diagnosing a very common clinical condition such as laryngomalacia in a timely and safe manner. Airway ultrasound may help narrow the differential diagnosis in cases of neonatal stridor and may avoid other unnecessary and costly explorations. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJjYjg1OTdmYTQ4YmU4NjQ3NGUwZmE2ZjZmN2RmOTdmMSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjMzODg2OTU2fQ.eL00l_aZB37Aov1rBFn8n_4dUDNRr6jNWdLOh4wvU53CHSZvsTWXuHccGxoJIRT33lNWUaED_myJ6sIqm2cNjozFthBWkmB7apAF_dM88VCKR6nvRKXTjpNQw-x8iS1-DENlH33yOLMcnET3-YyfFX3Utt1oc5H5WCbA1C9VJtVF0ShkMvulZeqixLB8mDjxYm_libv_6zrSbFK8sTQLBRPKqq2AtnojtFZ9qyiAcbO6Nt6smYJuqYfY10toDUfmLdCVLry9idmkoC7HsayCn6VeBUcJbzRpHgoJd91-7VGzciNXWsoaLnxgDHPoUDgYbBZwKVT6U3WkdzuT3svV4Q Download .mp4 (0.78 MB) Help with .mp4 files Video 1Airway ultrasound (transverse view at the level of the thyroid cartilage) in laryngomalacia. Note the near-complete collapse of the arytenoids with narrowing of the glottic opening during inspiration, accompanied by marked inspiratory stridor.eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJiMWE5MWRlMTMyN2JjOGNiYjA3YWU4MGQwODQxOGEzYiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjMzODg2OTU2fQ.eN03fYK__7Ua-GmBYddwWIrDdsgUdiS2YZWViUfaTob4dzUqD3iKP7_OkTG0k66l4Tw7O_Jkc_TmUIZ_7l7q-_q9okMe-j1IAHbMU6NMB-Ybd0-4O_WoJIQef1o5ZwNRNmJpIdb8wk6WFTi4yZKonfY7h_tLjNoumX3PVz0YJit6vn14htcn_M6-6xNpl9oAY2XtOBuUN_pftmUlogeVwvl16BkB598NyqqgRUH54tqLfmoryrJMrLybRz96CObl0FQlUUUHqMONt9tUYNQV5PyzJpLzolKwTIRsqVB_OAhtT3ZFPSzZVqggAE6Csy4U8aT4vyyAAaodp1hxjL41Mw Download .mp4 (1.07 MB) Help with .mp4 files Video 2Dynamic assessment of the larynx using airway ultrasound in a case of laryngomalacia. There is no obstruction of glottic opening during sleep (left). Mild inspiratory obstruction is observed on quite awake breathing (center), while near-complete inspiratory obstruction is observed during vigorous crying (right).eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJmNjQxY2FlNmJkYWFiMTYwNjEwOWM0OWY3YzNjZThkMyIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjMzODg2OTU2fQ.FSzQYrTmsaLd9h4L_vuYf2NdNTldjMb18zWp9JcVslqlO3i3AnpjrtTjhxb_nX8X6pGeLCj6sLqAbvCF6nB9rW0L9C2LR9HiDdwf5q5MWtZhuc8FE57Nk9yWjEdrIf3ysbt4p2BL2R26Qznkysk8_oaX8zylyWZmSCrhf1RP8pEneUunw7vV_8Z7vHM2a3bsWN-LsiZkPiH0jnsoAGsRCaU2YrKy8O45xFD0oTBeTEf1H44xMFWGm6L_1G2d4xTo3lo8H23Ik8vuiTWch-RuCyJ-A5VrDD-loywI_WWhzjmXr1LmTuHlcWSzeLGjVwB8UwNZylGsEbBVqwu3Tl8B3Q Download .mp4 (1.45 MB) Help with .mp4 files Video 3Airway endoscopy showing narrowing of the glottic opening caused by contact of arytenoids in the midline during inspiration. These findings are consistent with laryngomalacia." @default.
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• W3048284590 date "2020-12-01" @default.
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• W3048284590 title "Bedside Airway Ultrasound in the Evaluation of Neonatal Stridor" @default.
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